CITY & COUNTY OF SAN FRANCISCO



City & County of San Francisco

HUMAN RIGHTS COMMISSION

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HRC ATTACHMENT 4

Requirements for Micro-LBE Set-Aside Construction Contracts

For Contracts $250,000 and Less

___________________________________________________________________

PART I. GENERAL

1.01 SAN FRANCISCO ADMINISTRATIVE CODE CHAPTERS 12B AND 14B

A. To be eligible for this contract award, bidders must agree to comply with the Local Business Enterprise (LBE) requirements sanctioned by San Francisco Administrative Code Chapter 12B, Section 12B.4, and Chapter 14B (where applicable), and its implementing Rules and Regulations. Chapters 12B and 14B are administered and monitored by the San Francisco Human Rights Commission (HRC).

B. Chapters 12B and 14B and their implementing Rules and Regulations are incorporated by reference herein as though fully set forth and provide that the failure of any bidder or contractor to comply in good faith with these requirements shall be deemed a material breach of contract. Copies of both Chapters 12B and 14B and their implementing rules and regulations are available on the HRC website at sfhumanrights

C. Pilot Set-Aside Program

Under Section 14B.7(K)(1) of the Ordinance, the City may set-aside for competitive award to micro-LBEs any construction contract estimated by the Contract Awarding Authority to be $250,000 or less.

The competitive award requirements of the Municipal Code shall otherwise apply to contracts for the set-aside program, except that if (a) fewer than two micro-LBEs submit bids, or (b) the contract awarding authority determines that the contract would not be awarded at a fair market price, then the Contract Awarding Authority may reject all bids and remove the contract from the set-aside program.

Contracts that are set-aside for award to micro-LBEs shall not be subject to the LBE subcontracting goal under Section 14B.8. Micro-LBEs that subcontract any portion of a set-aside contract should subcontract to businesses certified as micro-LBEs to the maximum extent possible. Micro-LBEs that subcontract any portion of a set-aside contract must serve a commercially useful function based on the contract’s scope of work.

The Micro-LBE Prime must perform at least 50% of the contract work. Additionally, there should be no modifications to increase the contract amount unless there is an unforeseen situation—any such modification must have prior HRC approval.

For assistance with HRC Attachment 4, please contact the following number(s):

HRC Main Office (415) 252-2500 or LBE Certification Unit (415) 252-2537 or (415) 252-2530

For compliance and assistance with the Equal Benefits Program, please contact the HRC Main Office.

1.02 SUBMISSION OF HRC FORMS

Note: Failure to complete or submit any of the forms may cause the bidder to be deemed non-responsive and ineligible for contract award. For negotiated contracts: The schedule for the submission of forms will be established by the HRC in conjunction with the Contract Awarding Authority on a contract-by-contract basis.

A. Submit the following HRC Form with the Bid:

1. FORM 2A: HRC Contractor Participation Form

a. This Form must be completed and submitted with the Bid. Any bid submitted without a completed Form 2A may be deemed non-responsive and rejected. Bidders shall list on Form 2A the subcontractors and suppliers to be utilized in performing the contract, including first and lower tier subcontractors, suppliers, or service contractors such as truckers. Bidders must also specify the dollar amount of each subcontract and portion of work to be performed. The Micro-LBE Prime must perform at least 50% of the contract work or the bid will be deemed non-responsive. Micro-LBE Prime must specify the dollar amount and portion of work to be self-performed.

B. The apparent low bidder must submit the following forms by 5:00 p.m. on the fifth business day following Bid opening. If the HRC determines that the bidder is not acting in good faith in the timely and accurate submission of these forms, the bid may be determined non-responsive and rejected.

Note: No extensions of time to submit the forms are permitted except as specifically approved.

1. FORM 3: HRC Non Discrimination Affidavit: The bidder shall sign the Affidavit under penalty of perjury.

2. FORM 5: HRC Employment Form: A completed copy of Form 5 with the last 4 quarters of payroll tax records shall be submitted to the HRC office by the apparent low bidder for itself and for each listed subcontractor whose contract amount is $50,000 or more. The apparent low bidder and subcontractor(s) shall complete Sections I and II of Form 5 for the entire workforce in the offices that will be performing this contract. Form 5 shall be signed under penalty of perjury.

1.03 HRC CONTRACT PERFORMANCE FORMS

A. FORM 7: HRC Progress Payment Form: Submit to Contract Awarding Authority and to HRC for each payment request. Note: Page 2, column “A” of the form, ALL firms must be continuously listed including lower tier subcontractors for each payment request.

B. FORM 9: HRC Payment Affidavit: Submit within ten (10) working days to Contract Awarding Authority and HRC following receipt of each progress payment from the Contract Awarding Authority. This form must be submitted EVEN IF there is no subcontractor payment and until completion of the contract.

C. FORM 8: HRC Exit Report and Affidavit: To be submitted to the HRC and the Contract Awarding Authority with contractor’s final progress payment requests. Contractor must provide complete and accurate information on Section 2 of Form 8 and have it signed by LBE subcontractor and vendor (including lower tier LBE subcontractors, suppliers, and truckers.)

Upon request from HRC, the contractor must provide copies of certified payrolls for itself and all subcontractors.

D. FORM 10: HRC Contract Modification Form: No modification without prior HRC approval.

E. FORM 11: Workforce Tracking Form: This form must be submitted by the Prime and subcontractors (>$50,000) by the 15th of each month to HRC until contract completion.

F. Failure to submit any contract forms may result in sanctions under Chapter 14B, including but not limited to, withholding of progress and final payments.

1.04 NONCOMPLIANCE AND SANCTIONS

A. Non-Compliance with Chapter 14B

1. A complaint of discrimination or non-compliance concerning LBE participation initiated by any party after contract award will be processed in accordance with Chapter 14B and its implementing rules and regulations.

a. If the HRC Director determines that there is cause to believe that a contractor has failed to comply with any of the requirements of the 14B ordinance, HRC rules and regulations, or contract provisions pertaining to LBE participation, the HRC Director shall notify the Contract Awarding Authority and attempt to resolve the non-compliance through conference and conciliation.

b. If the non-compliance is not resolved through conference and conciliation, the HRC Director shall conduct an investigation and, where the Director so finds, issue a written Finding of Non-Compliance.

c. The Director’s finding shall indicate whether the contractor acted in good faith or whether noncompliance was based on willful or bad faith noncompliance with the requirements of Chapter 14B, HRC rules and regulations, or contract provisions pertaining to LBE participation.

1. Where the Director finds that the contractor acted in good faith, after affording the contractor notice and an opportunity to be heard, the Director shall recommend that the Contract Awarding Authority take appropriate action. Where the Director finds willful or bad faith noncompliance, the Director shall impose sanctions for each violation of the ordinance, HRC rules and regulations, or contract provisions pertaining to LBE participation, which may include:

a. If the contractor is a certified LBE, revoking that business' certification.

b. Declaring the contractor an irresponsible bidder and disqualifying the contractor from eligibility for providing goods or services to the City and County for a period of up to five years, with a right to review and reconsideration by the HRC after two years upon a showing of corrective action indicating violations are not likely to recur.

c. Determining that the contractor has willfully failed to comply with the provisions of Chapter 14B, sanctions are as follows:

i) reject all proposals;

ii) declare a proposal non-responsive;

iii) suspend a contract;

iv) withhold funds;

v) assess penalties;

vi) debarment;

vii) deny HRC certification;

viii) revoke HRC certification; or

ix) pursuant to 14B.7(H)(2), assess liquidated damages in an amount equal to the contractor’s net profit on the contract, 10% of the total amount of the contract or $1,000, whichever is greatest as determined by HRC.

d. The Director's determination of non-compliance is subject to appeal pursuant to Rule XV.B(7).

e. An appeal by a contractor to the Commission shall not stay the Director's findings.

f. The HRC Director may require such reports, information and documentation from contractors, subcontractors, contract awarding authorities, and heads of departments, divisions, and offices of the City and County as are reasonably necessary to determine compliance with the requirements of Chapter 14B.

B. Procedure for the Collection of Penalties is as follows:

1. The HRC Director shall send a written notice to the Controller, the Mayor and to all contract awarding authorities or City and County department officials overseeing any contract with the bidder or contractor that a determination of bad faith non-compliance has been made and that all payments due the bidder or contractor shall be withheld as agreed to by the bidder, contractor or subcontractor and the City and County.

2. The HRC Director shall transmit a report to the Controller and other applicable City departments to ensure that the liquidated damages are paid to the City.

PART II. BID DISCOUNT

2.01 The Bid Discount does not apply.

PART III. LBE SUBCONTRACTOR PARTICIPATION

01. Subcontracting Goal does not apply.

02. Substitution, removal, or contract modification of LBE: No listed subcontractor, supplier, trucker or other business listed on HRC C ontractor Participation Form shall be substituted, removed from the contract or have its contract, purchase order or other form of agreement modified in any way without prior HRC approval. In addition, any new subcontractors must have HRC’s prior approval.

PART IV. EMPLOYMENT NON-DISCRIMINATION AND ECONOMICALLY DISADVANTAGED WORKFORCE HIRING REQUIREMENTS

01. GENERAL

As a condition of contract award, Contractors and subcontractors’ shall comply with the nondiscrimination requirements as defined by Chapter 12B of the Administrative Code, and with the hiring of economically disadvantaged persons as required by the City's First Source Program, Chapter 83 of the Administrative Code and as required by the City's Public Works Contracting Policies and Procedures, Chapter 6 of the Administrative Code.

4.02 NON-DISCRIMINATION PROVISIONS

A. Prior to the award of the contract, Contractor shall agree in its bid that it will abide by Administrative Code Chapter 12B by not discriminating in the provision of benefits between its employees with spouses and its employees with domestic partners, as required by Chapter 12B.

B. Contractor shall promote and ensure equal employment opportunities for persons of all ethnic backgrounds and genders in the construction workforce. Prior to award of the contract, Contractor shall agree in its bid that it will abide by Administrative Code Chapter 12B by not discriminating against any employee or applicant for employment because of race, color, religion, ancestry, national origin, age, sex, sexual orientation, gender identity, domestic partner status, marital status, height, weight, disability or AIDS/HIV status, or association with members of classes protected under this chapter or in retaliation for opposition to any practices forbidden under Chapter 12B. This prohibition includes discrimination in employment, upgrading, demotion, transfer, recruitment advertising or recruitment, layoff or termination, rates of pay or other forms of compensation, and selection for training including apprenticeship. Contractors shall place the same requirements in its subcontracts.

C. Contractor and its subcontractors shall send to each labor union with which they have a collective bargaining agreement a notice advising the union of this commitment to nondiscrimination and shall post copies of this notice in conspicuous places available to employees and applicants for employment.

D. Neither the provision of a collective bargaining agreement nor the failure of a union with whom contractor has a collective bargaining agreement to refer any group of persons for employment shall excuse contractors’ or its subcontractors’ obligations not to discriminate under these provisions.

E. Contractor and its subcontractors shall ensure that all forepersons, superintendents and other on-site supervisory personnel maintain a working environment free of harassment, intimidation, and coercion.

F. Contractor and its subcontractors shall ensure that all facilities and company activities are non-segregated except that separate or single-user toilet and changing facilities shall be provided to accommodate all workers.

G. Contractor agrees that the ratio of apprentices to journeypersons employed by contractor on this job will comply with the ratio required on public works projects by California Labor Code section 1777.5.

H. Upon HRC request, an authorized representative of contractor, its subcontractors and suppliers will actively participate in compliance review meetings with a representative of the HRC to review the implementation of these nondiscrimination requirements. The authorized representative of the company in attendance must have authority to commit the organization. Contractor shall be responsible to notify and to require the attendance of its subcontractors at such meetings. Contractors and subcontractors shall abide by any nondiscrimination program imposed by the HRC under Chapter 12B.4.

I. Non-Compliance and Sanctions:

1. A complaint of discrimination in employment initiated by any party after contract award will be processed in accordance with the HRC Rules of Procedures, adopted pursuant to Chapter 12B of the San Francisco Administrative Code.

2. A finding of discrimination may result in imposition of financial penalties and debarment from City contracting.

4.03 employment REPORTING REQUIREMENTS

A. The apparent low bidder and each of its subcontractors with a listed subcontract that equals or exceeds $50,000 shall submit HRC Employment Form to report information and statistics concerning its workforce and hiring plans.

B. Contractor shall inform the HRC contract compliance staff of any subcontractor who is replaced during performance of the contract. All replacement subcontractors must submit HRC Employment Form within 15 days of award of the subcontract.

C. Workforce Tracking Form (Form 11) shall be submitted in Section 1.03E.

D. On the request of the HRC, contractor and its subcontractors shall permit access to all records that may be pertinent to workforce participation on the contract. Such information will be safeguarded.

4.04A ECONOMICALLY DISADVANTAGED HIRING REQUIREMENT

(PUBLIC WORKS INSIDE SAN FRANCISCO BOUNDARIES)

A. Contractor promises to make good faith efforts, with the assistance of community based organizations designated by the City or local labor union hiring halls, to hire qualified economically disadvantaged residents of San Francisco to comprise no less than 50% of contractor’s total construction work force, measured in labor force work hours. In satisfying this requirement, Contractors shall follow the requirements and procedures of the City's CityBuild Program and/or the City's First Source Hiring Program, as established by Contractor's agreement with the City. Definitions of "qualified" and "economically disadvantaged" are set forth below in Sections B and C.

1. Contractor shall keep, and provide to the City, an accurate record showing the name, place of residence, hours employed and per diem pay of each person employed by contractor, including full-time, part-time, permanent and temporary employees.

2. Contractor shall keep, and provide to the City, an accurate record describing in detail contractor’s good-faith efforts to employ economically disadvantaged persons as required above.

3. Failure to abide by these contract provisions may result in the imposition of sanctions and penalties, including but not limited to those enumerated in the San Francisco Administrative Code, Sections 6.80 through 6.83 and 83.

4. The HRC, in consultation with the City's CityBuild Program, and the City's First Source Hiring Program, will monitor and enforce the requirements set forth above and in accordance with their jurisdiction.

B. Definitions from Administrative Code section 6.22(G):

1. “Qualified individual” shall mean an individual who:

a. is eligible for certified apprenticeship program in an applicable trade,

b. has completed certified apprenticeship program in an applicable trade, or

c. has completed comparable time in an applicable trade.

2. “Economically disadvantaged individual” shall mean an individual who has been unable to secure employment in his or her trade for more than 20 working days in the past six months, or whose annual maximum income falls within the income limits established by the Mayor’s Office of Community Development Block Grant programs.

C. Definitions from the First Source Hiring Program, Administrative Code Section 83.4.

(i) "Qualified" with reference to an economically disadvantaged individual shall mean an individual who meets the minimum bona fide occupational qualifications provided by the prospective employer to the San Francisco Workforce Development System in the job availability notices required by the Program,

(ii) "Economically disadvantaged individual" shall mean an individual who is either: (1) eligible for services under the Workforce Investment Act of 1988 (WIA) (29 U.S.C.A 2801 et seq.), as determined by the San Francisco Private Industry Council; or (2) designated "economically disadvantaged" by the First Source Hiring Administration, as an individual who is at risk of relying upon, or returning to, public assistance, as set forth in Administrative Code section 83.4(i).

4.04B. ECONOMICALLY DISADVANTAGED HIRING REQUIREMENT

(PUBLIC WORKS OUTSIDE SAN FRANCISCO BOUNDARIES)

A. Contractor promises to make good faith efforts, with the assistance of community-based organizations designated by the City or local labor union hiring halls, to hire qualified economically disadvantaged individuals. In satisfying this requirement, Contractors shall follow the requirements and procedures of the City's CityBuild Program and/or the City's First Source Hiring Program, as established by Contractor's agreement with the City. Definitions of "qualified" and "economically disadvantaged" are set forth below in Section B.

1. Contractor shall keep, and provide to the City, an accurate record showing the name, place of residence, hours employed and per diem pay of each person employed by contractor, including full-time, part-time, permanent and temporary employees.

2. Contractor shall keep, and provide to the City, an accurate record describing in detail contractor's good faith efforts to employ economically disadvantaged persons as required above.

3. Failure to abide by these contract provisions may result in the imposition of sanctions and penalties, including but not limited to those enumerated in the San Francisco Administrative Code, Sections 6.80 through 6.83 and 83.

4. The HRC will assist the City's CityBuild Program Administration and the City's First Source Hiring Administration in monitoring and enforcing the requirements set forth above and in accordance with their respective jurisdictions.

B. Definitions from the First Source Hiring Program, Administrative Code Section 83.4.

(i) "Qualified" with reference to an economically disadvantaged individual shall mean an individual who meets the minimum bona fide occupational qualifications provided by the prospective employer to the San Francisco Workforce Development System in the job availability notices required by the Program,

(ii) "Economically disadvantaged individual" shall mean an individual who is either: (1) eligible for services under the Workforce Investment Act of 1988 (WIA) (29 U.S.C.A. 2801 et seq.), as determined by the San Francisco Private Industry Council; or (2) designated "economically disadvantaged" by the First Source Hiring Administration, as an individual who is at risk of relying upon, or returning to, public assistance, as set forth in Administrative Code section 83.4(i).

|FORM 2A: HRC contractor participation FORM |

|SECTION 1: BIDDER INFORMATION |

|CONTRACT NO: | |CONTRACT NAME: |      |

|BIDDER: |      | Check if you are a certified Micro-LBE |

| |BID AMOUNT: | |

| |$      |Minority –owned = MBE |

| | |Woman-owned = WBE |

| | |Other Business Owned = OBE |

|ADDRESS: |      | |

| |CONTRACT NAME: | |

| |      | |

|CITY/ZIP: |      | |

|CONTACT PERSON: |      | |

|CONTACT Phone: |      | |

|BID AMOUNT: |$      | |

| |

|SECTION 2: CONTRACTOR PARTICIPATION |

|This section is to be completed by the bidder. Bidder must perform at least 50% of the work. Bidder shall identify below its participation and the subcontractors |

|to be utilized in performing the Contract, including first and lower tier subcontractors, suppliers, or service contractors such as truckers and specifying the |

|dollar value of Work to be performed (for the entire contract.) (This form is also to be completed for all contract amendments, modifications, supplements or change|

|orders that cumulatively increases the original contract amount by more than 20%.) |

|* Type: Indicate Prime (P) and if subcontractor is a first tier (F), lower tier (L), supplier (S) or service contractor (SC, e.g. trucker) |

|TYPE *|PRIME, |BID ITEMS/PORTION OF WORK |% OF WORK |INDICATE |*If an LBE, |$ AMOUNT OF |

| |SUBCONTRACTOR, |(describe the work) | |Micro-LBE or |identify, MBE, |CONTRACT |

| |SUPPLIER, | | |Small LBE |WBE, | |

| |SERVICE CONTRACTOR | | | |or OBE | |

|   |      |      |      |      |      |      |

|   |      |      |      |      |      |      |

|   |      |      |      |      |      |      |

|   |      |      |      |      |      |      |

|   |      |      |      |      |      |      |

| |TOTAL PERCENTAGE OF WORK = |100% |total base bid: |      |

| | | |(all contract amounts must be | |

| | | |equal to the base bid) | |

|I declare, under penalty of perjury under the laws of the State of California, that I am utilizing the above contractors for the portions of work and amounts as |

|reflected in the Bid Documents for this Contract. |

|Owner/Authorized Representative (Signature): | |Date: |      |

|Owner/Authorized Representative (Print): |      |Title |      |

* MBE = Minority Business Enterprise, WBE = Women Business Enterprise, OBE = Other Business Enterprise. See HRC website () for each firm’s status.

|SECTION 3: contractor/Supplier information |

|Provide information for each firm listed in Section 2 of this form. Vendor numbers of LBE firms are located on the HRC LBE Website at sfhumanrights.|

|Firms that have previously worked on City contracts may already have a vendor number. Use additional sheets if necessary. |

| |

|firm name: |      |vendor #: |      |

|address: |      |federal id #: |      |

|CITY, st, zip: |      |phone: |      |FAX: |      |

|service: |      |

|firm name: |      |vendor #: |      |

|address: |      |federal id #: |      |

|CITY, st, zip: |      |phone: |      |FAX: |      |

|service: |      |

|firm name: |      |vendor #: |      |

|address: |      |federal id #: |      |

|CITY, st, zip: |      |phone: |      |FAX: |      |

|service: |      |

|firm name: |      |vendor #: |      |

|address: |      |federal id #: |      |

|CITY, st, zip: |      |phone: |      |FAX: |      |

|service: |      |

|firm name: |      |vendor #: |      |

|address: |      |federal id #: |      |

|CITY, st, zip: |      |phone: |      |FAX: |      |

|service: |      |

|firm name: |      |vendor #: |      |

|address: |      |federal id #: |      |

|CITY, st, zip: |      |phone: |      |FAX: |      |

|service: |      |

|FORM 3: hrc NON-DISCRIMINATION AFFIDAVIT |

| |

|1. I will ensure that my firm complies fully with the provisions of Chapter 14B and its implementing Rules and Regulations and attest to the truth and accuracy |

|of all information provided regarding such compliance. |

| |

|2. I acknowledge and agree that any monetary penalty assessed against my firm by the Director of the HRC shall be payable to the City and County upon demand. I |

|further acknowledge and agree that any monetary penalty assessed may be withheld from any monies due to my firm on any contract with the City and County of San |

|Francisco. |

| |

|3. I declare and swear under penalty of perjury under the laws of the State of California that the foregoing statements are true and correct and accurately |

|reflect my intentions. |

| |

|Signature of Owner/Authorized Representative: | |

|Owner/Authorized Representative (Print): |      |

|Name of Firm (Print): |      |

|Title and Position: |      |

|Address, City, ZIP |      |

|Federal Employer Identification Number (FEIN): |      |

|Date: |      |

|FORM 5: HRC EMPLOYMENT FORM |

|This form shall be completed by the Bidder and every listed subcontractor (see Section 4.03A) and supplier with a subcontract or purchase order of $50,000 or more.|

|The apparent low Bidder shall submit these forms directly to the HRC Compliance Officer by 5:00 p.m. on the fifth business day after Bid opening. |

| |

|This form must be completed and returned in a timely manner or the Bid may be determined non-responsive and rejected. |

|Contract Number: |      |Contract Name: |      |

|SECTION 1. |

|Firm: |      |Vendor Number: |      |

|Address: |      |

|City: |      |STATE: |      |ZIP: |      |

|Phone: |      |Type of Contractor’s License(s): |      |Federal I.D. Number: |      |

|SECTION 2. Submit copies of the last four (4) quarters of the California Quarterly Payroll Tax Record. In addition, list below all employees that you plan to |

|utilize on this project. |

|Date of most recent |EMPLOYEE NAME |TRADE |CLASSIFICATION |RACE1 |SEX |

|hire | |(carpenter, admin.,|(journeyperson, apprentice/secretary, | | |

| | |sales) |outside sales) | | |

|      |      |      |      |      |  |

|      |      |      |      |      |  |

|      |      |      |      |      |  |

|      |      |      |      |      |  |

|      |      |      |      |      |  |

|      |      |      |      |      |  |

|      |      |      |      |      |  |

|      |      |      |      |      |  |

|      |      |      |      |      |  |

|      |      |      |      |      |  |

|      |      |      |      |      |  |

|      |      |      |      |      |  |

|      |      |      |      |      |  |

|      |      |      |      |      |  |

|      |      |      |      |      |  |

1. Indicate which of the following: American Indian/Alaskan Native, Asian/Pacific Islander, Black, Filipino, Latino, White, or Other.

2. Bidder shall make good faith efforts with the assistance of community based organizations designated by the Contract Awarding Authority or local labor union hiring hall to hire economically disadvantaged individuals as required in Section 4.04 of this Attachment.

3. List below your estimate of new hires by trade and classification.

|Trade |Subject to |Number of |Classification |Estimated Start Date|Total Hours Estimated |

| |Collective |Estimated | | |in On Contract |

| |Bargaining? |New Hires | | | |

|      |    |    |      |      |      |

|      |    |    |      |      |      |

|      |    |    |      |      |      |

|      |    |    |      |      |      |

|      |    |    |      |      |      |

|      |    |    |      |      |      |

|      |    |    |      |      |      |

|      |    |    |      |      |      |

|      |    |    |      |      |      |

|      |    |    |      |      |      |

SECTION 3.

I will ensure that my firm complies fully with the nondiscrimination provisions of Chapter 12B.

I acknowledge and am hereby advised that upon a finding of non-compliance with the nondiscrimination provisions of Chapter 12B, the City is authorized to impose penalties which may include financial penalties and disqualification from providing goods and services to the City and County of San Francisco for a period not to exceed two (2) years.

I declare that the above information is true and accurate and swear under penalty of perjury under the laws of the State of California.

| | |      |

|Owner/Authorized Representative (Signature) | |Name of Firm |

|      | |      |

|Name and Title (Print) | |Date |

|FORM 7: HRC progress payment form |

| |

| |

|To be completed by contractor and submitted to the Contract Awarding Authority with its monthly progress payment request. |

| |

|TRANSMITTAL |

|TO: |Resident Engineer or Inspector |COPY: |HRC Contract Compliance Officer |

|FROM: |      |Date: |      |

| |

|SECTION 1. Fill in all the blanks |

|Contract Number: |      |Contract Name: |      |

|Reporting Period From: |      |To: |      |Progress Payment No: |      |

| |

| |

|The information submitted on Sections 1 and 2 of this form must be cumulative for the entire contract as opposed to individual task orders. Additionally, the |

|information submitted on Sections 1 and 2 of this form must be accurate for the progress payment period immediately preceding that of the current payment |

|application attached herewith. |

|1. Amount of Prime Contract: |$      |

|2. Amount of Change Orders, Amendments and Modifications to Date: |$      |

|3. Total Contract to Date including Change Orders, Amendments and Modifications (Line 1 + Line 2): |$      |

|4. Amount Invoiced this submittal period: |$      |

|5. Total Amount Requested to Date including Retainage Received |$      |

|6. Amount of Progress Payments Requested to Date (Line 4 + Line 5): |$      |

|7. Percent Complete (Line 6( Line 3): |   % |

|Contractor must sign this form |

| |

|Owner/Authorized Representative (Signature) |

|      |

|Name and Title (Print) |

|      |

|Firm Name |

|      |      |

|Telephone |Fax |

| |      |

| |Date |

| |

|SECTION 2. |

|Provide a complete listing in the following table for Contractor and ALL subcontractors and suppliers (including 2nd and/or 3rd tier subcontractors). Make copies of this sheet as needed. Attach copies of all |

|invoices from subcontractors supporting the information tabulated on this form and Contractor’s invoice and Contract Payment Authorization for the immediately preceding progress payment period. |

| |

|Notes: 1) All firms be continuously listed on column “A” regardless if a firm is requesting payment and |

|2) Failure to submit all required information may lead to partial withholding of progress payment. (See Chapter 14B) |

| |

|A |B |C |D |E |F |G |H |

|Name of Firm | | | | |Amount Invoiced this |Amount of Progress | |

|List Contractor and all subcontractors, |Service Performed | | |Total Amount of |Reporting Period |Payments Received and | |

|(including lower tier subcontractors and | |Amount of Contract or |Amount of Change |Contract or Purchase | |Invoiced to Date, |Percent Completed |

|suppliers. Indicate if the firm is an | |Purchase Order at time|Orders/Modifications |Order to Date +/( | |including amount |to Date |

|LBE | |of Award |to Date |Change | |invoiced this reporting|(G÷E) |

| | | | |Orders/Modifications | |period (F) | |

| | | | |(C + D) or (C(D) | | | |

|      |      |      |      |      |      |      |   % |

|      |      |      |      |      |      |      |   % |

|      |      |      |      |      |      |      |   % |

|      |      |      |      |      |      |      |   % |

|      |      |      |      |      |      |      |   % |

|      |      |      |      |      |      |      |   % |

| | | | | | | | |

| | | | | | | | |

| | | | | | | | |

| |      |      |      |      |      |      |   % |

|      |      |      |      |      |      |      |   % |

|      |      |      |      |      |      |      |   % |

|LBE Sub-Totals |      |      |      |      |      |      |   % |

|CONTRACT TOTALS |      |      |      |      |      |      |   % |

|FORM 9: HRC payment affidavit |

| |

| |

|To be completed and submitted by contractor and submitted to the Contracting Awarding Authority and HRC within ten (10) working days following receipt of each |

|progress payment from the Contracting Awarding Authority. |

| |

|TRANSMITTAL |

|TO: |Resident Engineer or Inspector |COPY: |HRC Contract Compliance Officer |

|FROM: |      |Date: |      |

| |

|List the following information for each progress payment received from the Contracting Awarding Authority. Use additional sheets to include complete payment |

|information for all subcontractors (including lower tier subcontractors) and suppliers utilized on this Contract. Failure to submit all required information may |

|lead to partial withholding of progress or final payment. |

|Contract Number: |      |Contract Name: |      |

|Contract Awarding Department: |      |

|Progress Payment No.: |      |Period Ending: |      |

|Amount Received: |$      |Date: |      |Warrant/Check No.: |      |

|Subcontractor/Supplier Name |Business Address |Amount Paid |Payment Date |Check Number |

|      |      |      |      |      |

|      |      |      |      |      |

|      |      |      |      |      |

|      |      |      |      |      |

|      |      |      |      |      |

|      |      |      |      |      |

|      |      |      |      |      |

|      |      |      |      |      |

| |

|I declare, under penalty of perjury under the laws of the State of California, that the above information is complete and that the tabulated amounts paid to date |

|are accurate and correct. Contract must sign this form. |

| |

|Owner/Authorized Representative (Signature) |

|      |

|Name (Print) |

|      |

|Title (Print) |

|      |

|Firm Name |

|      |      |

|Telephone |Date |

|FORM 8: HRC exit REPORT AND AFFIDAVIT |

| |

| |

|Prime Contractor must complete and sign this form (Sections 1 and 3) for each LBE subcontractor (incl. lower tier LBE subcontractors), supplier and trucker. LBE |

|subcontractors must complete and sign Section 2 of this form. These forms should be submitted to the Contract Awarding Authority with the final progress payment |

|request. |

| |

|TRANSMITTAL |

|TO: |Resident Engineer Inspector |COPY: |HRC Contract Compliance Officer |

|FROM (Contractor): |      |Date Transmitted: |      |

| |

|SECTION 1. |

|Reporting Date: |      |Contract Name: |      |

|Name of LBE: |      |Portion of Work (Trade): |      |

|Original LBE Contract Amount: |$       |

|Change Orders, Amendments, Modifications |$       |

|Final LBE Contract Amount: |$       |

|Amount of Progress Payments Paid to Date: |$       |

|Amount further subbed out to non LBE firms: |$       |

|Amount Owing including all Change Orders, Amendments and Modifications |$       |

|Explanation by contractor if the final contract amount for this LBE is less than the original contract amount: |

|      |

|SECTION 2. |

|To be signed by the LBE Subcontractor or vendor: |

|I agree I disagree |

|Explanation by LBE if it is in disagreement with the above explanation, or with the information on this form: |

|      |

| | |      |

|Owner/Authorized Representative (Signature) | |Name and Title (Print) |

|      | |      |      |

|Firm Name | |Telephone |Date |

| | | | |

|SECTION 3. |

| |

|I declare, under penalty of perjury under the laws of the State of California, that the information contained in Section 1 of this form is complete, that the |

|tabulated amounts paid to date are accurate and correct, and that the tabulated amounts owing will be paid within three (3) days after the date of the City’s final|

|payment under the Contract. |

| | | |

|Owner/Authorized Representative (Signature) | | |

|      | | |

|Name and Title (Print) | | |

|      | | |

|Firm Name | | |

|      |      | | | |

|Telephone |Date | | | |

|FORM 10: HRC Contract modification form |

|Contractor must submit this form with the required supporting documentation when processing the first contract amendment, modification, or change order that |

|cumulatively increases the original contract amount by more than 20%, and then for all subsequent requests. (This provision applies only to contracts |

|originally valued at $50,000 or more.) |

|Name of Project/Contract Title: |      |

|Original Contract Amount: |      |

|Contract Amount as Modified to Date: |      |

|Amount of Current Modification Request: |      |

REQUIRED ATTACHMENTS:

1. Revised Form 2A reflecting the new overall contract amounts for the prime contractor, subcontractors, and vendors.

1. A list of all prior contract amendments, modifications, supplements, and/or change orders leading up to this modification, including those leading up to the amendment which increased the original contract amount by more than 20%.

2. A list of the contractors and vendors working on this amendment, modification, or change order with the contract dollars for each individual firm.

3. A brief description of the work to be performed under this amendment, modification, or change order.

| |

|Owner/Authorized Representative (Signature) |

|      |

|Name (Print) Title |

|      |

|Firm Name |

|      |      |

|Telephone |Date |

FORM 11: HRC WORKFORCE TRACKING FORM

This form is submitted by the Prime Contractor and Subcontractors (> $50,000) by the 15th of each month to HRC until completion of the contract.

|City Department Name: |      |

|Contract Number: |      |Contract Name |      |

Are you the Prime Contractor for this project? YES NO

|Company |      |Percent of Work Completed to Date: |      |

|Address |      |Page       of       |

|City |      |Payroll Month & Year Ending: |      |

|State & ZIP |      |Print Name of Preparer |      |

|Phone |      |Signature of Preparer |      |

| | |

|Social Security Number |Employee & Address |

Race Codes: A=Asian/Pacific Islander, B= Black, F= Filipino, H= Hispanic, N= Native American /Alaskan Native, O= Other, U= Unknown, W= White

|Social |Employee & Address |Trade |Class |Total Hours |

|Security | | | | |

|Number | | | | |

|1101 |Boilermaker | |2 |Foreperson |

|1201 |Bricklayer | |3 |Journeyperson |

|1202 |Carpenter | |4 |Apprentice |

|1203 |Carpet Worker | |5 |Teamster |

|1302 |Cement Mason | |6 |Admin. Staff |

|2223 |Construction Teamster | |7 |Laborer |

|1204 |Drywall Installer (Gypsum) | |8 |Unknown |

|1102 |Electrical Worker | | | |

|1103 |Elevator Constructor | | | |

|2502 |Field Office | | | |

|2503 |Field Supervisor | | | |

|1205 |Glazier | | | |

|1401 |Gunite Worker | | | |

|1206 |Hod Carrier (Bricklayer) | | | |

|1207 |Hod Carrier (Plasterer) | | | |

|1209 |Iron Worker (Rebar) | | | |

|1208 |Iron Worker (Structural) | | | |

|2403 |Laborer | | | |

|2501 |Laborer Foreperson | | | |

|1210 |Lather | | | |

|1212 |Mill Worker | | | |

|1104 |Millwright | | | |

|1213 |Operating Engineer | | | |

|1214 |Painter | | | |

|1223 |Pile Butt | | | |

|1105 |Pile Driver | | | |

|1211 |Plasterer | | | |

|1106 |Plumber | | | |

|1303 |Roofer | | | |

|1402 |Sandblaster | | | |

|1215 |Sheet Metal Worker | | | |

|1216 |Soft Tile Worker (Linoleum/Floor Layers/Asphalt) | | | |

|1107 |Sprinkler Fitter | | | |

|1108 |Steam Fitter | | | |

|1217 |Stone Mason | | | |

|1218 |Taper (Drywall) | | | |

|2224 |Teamster Foreperson | | | |

|1219 |Terrazzo Mechanic | | | |

|1221 |Tile Helper | | | |

|1222 |Tile Setter | | | |

|2225 |Trucker | | | |

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